Although pectoralis major plays an important role as a prime or assistant mover for the varied range of shoulder movement, there was no significant functional loss in ordinary activities in case of congenital absence of this muscle, because of compensation of surrounding muscles. This report describes a 22-year-old soldier with unilateral congenital absence of pectoralis major, who had difficulties in specific upper extremity movement, such as throwing or climbing. There was no visible or radiological evidence of associated anomalies of ipsilateral upper extremity. Electrodiagnostic study showed normal findings except delayed latency of medial pectoral nerve supplying rudimentary pectoralis minor of the involved side. On isokinetic study of movement for both shoulders, peak torque and average power for horizontal adduction were markedly-diminished on the involved side.
Adult ; Human ; Male ; Movement ; Neural Conduction ; Pectoralis Muscles/*abnormalities ; Shoulder/*physiopathology

The chest wall and breast asymmetry varies from severe pectus deformities to an isolated breast hypoplasia. In addition to the chest abnormality, a natural-looking breast is the aesthetic challenge in women. Considering that the most common indication of operations is an aesthetic one, any procedures leaving much scars and deformities at the donor site aren't preferred by patients. A 31-year-old female had a 4 x 10 x 2.5 cm sized pectus-excavatum deformity on her right chest, and a slightly hypoplastic breast compared with the left one. The nipple of her right breast was located supero-medially and pectoralis muscles were preserved to some degree at the right side. Through a bilateral submammary and subxiphoid incision, the deformed cartilage was resected from 3th to 7th rib bilaterally and chondrotomy was done at the sternum partially. After this modified Ravitch's technique, two-metal pins were fixated between right 4th~5th ribs and left 4th rib, and the depressed sternum was elevated over the metal pins. The deficient volume of her right breast was corrected by inserting a siliconegel breast implant (120 cc) submuscularly to restore a adequately projected breast. The results of twelve months' follow-up demonstrated a symmetric and well- projected breast. There were no significant chest wall depression or capsular contracture. Restoring a fundamental bony structure would decrease the amount of augmentation needed in the soft tissues. And a silicone-gel breast implant may be used as an the alternative material for whose axillary fold is preserved to some degree.
Adult ; Breast Implants ; Breast* ; Cartilage ; Cicatrix ; Congenital Abnormalities* ; Contracture ; Depression ; Female ; Follow-Up Studies ; Humans ; Nipples ; Pectoralis Muscles ; Ribs ; Sternum ; Thoracic Wall* ; Thorax* ; Tissue Donors

OBJECTIVETo search for an ideal method to repair large facial defects.

METHODSOne or two soft tissue expanders were implanted at the clavicular-pectoral region. After fully expansion, a clavicular-pectoral skin flap was designed and created with similar color, texture, and size to the facial defect. The flap would pass over the neck and transfer to the face to repair a large defect.

RESULTS10 cases were treated with this method. All have been followed up for 12-18 months with satisfactory results.

CONCLUSIONThe large facial defects could be repaired by the expanded clavicular-pectoral skin flap without damaging the natural neck contour and donor site abnormality was avoided. The patients get an aesthetic look and good function.

Adolescent ; Adult ; Child ; Clavicle ; Face ; abnormalities ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Pectoralis Muscles ; transplantation ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; methods ; Surgical Flaps ; Treatment Outcome

OBJECTIVETo explore a method for reconstruction of Poland's chest wall deformity.

METHODSThe customized, textured silicone prosthesis was fabricated from a soft silicone polymer that approximated to the softness of the pectoralis major muscle. A lateral incision of 6 cm on the affected chest was made. After a subcutaneous pocket above the ribs was created through the incision, the prosthesis was placed in the pocket.

RESULTSSince October 2000, chest wall reconstruction for Poland's syndrome deformity has been performed in 7 male patients (18 to 45 years) with the customized soft silicone prosthesis. Follow-up for 3 to 17 months showed that all patients were satisfied with the aesthetical results. Seroma occurred in 2 patients, and needle aspiration was used to solve the problem.

CONCLUSIONThis method is simple and less traumatic. The reconstructed chest wall approximates to the softness and appearance of the contralateral pectoralis muscle.

Adolescent ; Adult ; Humans ; Male ; Middle Aged ; Pectoralis Muscles ; Poland Syndrome ; surgery ; Prostheses and Implants ; Prosthesis Implantation ; methods ; Reconstructive Surgical Procedures ; methods ; Ribs ; Silicones ; therapeutic use ; Thoracic Wall ; abnormalities ; surgery

Poland syndrome, which is characterized by an absence of pectoralis muscles and their innervated nerves, is marked by variable chest wall defects due to deficits of 2nd, 3rd, 4th, and 5th ribs and costal cartilage. Additionally, there are other reported combined anomalies of the heart, lung, kidney, ipsilateral hand and foot associated with the syndrome. The lung on the side with the thoracic deformity is more hypoplastic or smaller than the lung on the unaffected side, which can cause herniation of the lung or paradoxical ventilatory movement in severe cases, thereby increasing the risk of respiratory depression and hypoxemia. Patients may have profound lung complications due to depressed respiratory muscle function and exacerbation of the underlying chronic pulmonary disease during the perioperative period. These patients also show increased risk of malignant hyperthermia and therefore require careful attention during general anesthesia. We report here an anesthetic experience during reconstruction surgery of a chest wall defect in a male patient with Poland syndrome.
Anesthesia ; Anesthesia, General ; Anoxia ; Cartilage ; Congenital Abnormalities ; Foot ; Hand ; Heart ; Humans ; Kidney ; Lung ; Lung Diseases ; Male ; Malignant Hyperthermia ; Pectoralis Muscles ; Perioperative Period ; Poland ; Poland Syndrome ; Respiratory Insufficiency ; Respiratory Muscles ; Ribs ; Thoracic Wall ; Thorax